Costa Rica

TRAVEL DATE: 11/01/2020 TERRITORY: M5

Costa Rica: A World of Nature featuring Tortuguero National Park, Arenal Volcano & Manuel Antonio National Park

RES#: 954293

For Reservations Contact: Jennie Smith (715) 232-1275 email: smithjen@uwstout.edu University of Wisconsin- Stout, 320 Broadway St S, Menomonie, WI 54751-1819 A deposit of $500 per person is due upon reservation. Reservations are made on a first come, first served basis. Reservations made after the deposit due date of March 25, 2020 are based upon availability. Final payment due by September 02, 2020. Deposits are refundable up until April 01, 2020. YOUR INFORMATION: Clearly print your full name (first/middle/last) as it appears on your government issued travel documentation. IMPORTANT: In order to avoid any unnecessary change fees, it is imperative that all guest names are entered correctly from the start. The information below must be the legal name and be 100% identical to the ID being used to travel including middle names or suffixes .

First:

Middle:

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Suffix:

Nickname:

Gender: ( ) Male ( ) Female Date of Birth: month

day

year

Address:

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Email Address:

Passport Number:

Expiration Date: (month/day/year)

Date of Issuance: (month/day/year)

City, State, Country of Issuance:

Citizenship:

Should you become ill or injured, whom should we contact (not traveling with you):

Phone: (

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ROOMING WITH:  Check if address is the same as Passenger #1

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Middle:

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Collette and UW-Stout are not authorized to pair single occupancy rooms due to liability reasons AIR GATEWAY: Departure airport for this tour: Air Seat Request: ( ) Aisle ( ) Window ( ) Next To Traveling Companion

Collette cannot guarantee your seat preference. If you have not purchased air through Collette and wish to purchase transfers, you must transfer at our pre-scheduled times. Please be advised, when travelling as part of a group, many airlines do not provide seat assignments. Preferred seating may be available for an additional charge. “Federal law forbids carriage of hazardous materials such as aerosols, fireworks, lithium batteries & flammable liquids aboard the aircraft in your checked or carry-on baggage. A violation can result in 5 years’ imprisonment and penalties of $250,000 or more. Details on prohibited items may be found on TSA’s “prohibited items” web page: http://www.tsa.gov/traveler-information/prohibited-items.” TRAVEL PROTECTION: ( ) Yes, I wish to purchase travel protection $315 ( ) No, I decline If you choose not to purchase Collette's Waiver Insurance Plan, you will incur penalties for changes and cancellations. Travel Protection Payment is due with first deposit. The Waiver Fee does not cover any single supplement charges which arise from an individual’s traveling companion electing to cancel for any reason prior to departure. The single supplement will be deducted from the refund of the person who cancels. (There is coverage under Part B which includes a single supplement benefit of $1,000 for certain covered reasons. See Part B for details.) ON TOUR ACTIVITIES: Please choose one of the following on tour activities Please Choose One: ( ) Primary Forest Walking Tour ( ) Scenic Horseback Ride Please Choose One: ( ) Volcano Hike ( ) Sky Adventures PLEASE MAKE CHECKS PAYABLE TO: Collette ( ) Check ( ) Credit Card

Waiver/Insurance Amount: $___________________ Deposit Amount: $___________________ Total amount enclosed: $___________________

Cardholder Name (if paying by Credit Card):

Cardholder Billing Address:  Check if address is the same as above

Cardholder Phone:

Amount: $

Credit Card Number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Expiration Date: _ _ _ _ M M Y Y SIGNATURE REQUIRED for acceptance of the below conditions and agreement to credit card use:

Date: I agree to pay according to the card issuer agreement. I understand and accept the cancellation policy, terms and conditions. See http://www.gocollette.com/about- collette/terms-and-conditions for full terms and conditions of your purchase. Important Conditions: Your price is subject to increase prior to the time you make full payment. Your price is not subject to increase after you make full payment, except for charges resulting from increases in government-imposed taxes or fees.